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Olee otu lactic acidosis si amalite

Ọrịa siri ike nke lactate na-abanye ngwa ngwa n’ọbara bụ mmiri ara ehi acidosis. Lactic acidosis na ụdị ọrịa shuga nke mellitus nke 2 nwere ike ime mgbe ejiri ọgwụ na-ebelata shuga. Mmeghachi omume a n'akụkụ dị na njikere nke biguanide dịgasị iche iche (Metformin, Bagomet, Siofor, Glyukofazh, Avandamet). E kee ọnọdụ ahụ ụzọ abụọ:

Pịnye Actic acidosis - hypoxia anụ ahụ. Ahụ mmadụ enweghị oxygen na ọrịa dị oke mkpa: sepsis, uhere ure, ọnọdụ nke ọrịa imeju ma ọ bụ mgbatị ahụ siri ike.
Ladị B lactic acidosis enweghị njikọ hypoxia nke anụ ahụ. Ọ na - eme n'oge ọgwụgwọ ụfọdụ ọgwụ megide ọrịa shuga na nje HIV. Achịcha acid nke ụdị a na - egosiputa onwe ya megide nzụlite mmanya ma ọ bụ ọrịa imeju na - adịghị ala ala.

A na-edozi acid acidis n’ihi nsogbu nke usoro metabolic nke anụ ahụ. Ọnọdụ ọrịa na - eme mgbe:

Ọrịa shuga 2dị 2.
Formmeju ọbara Metformin (enwere ọgwụ ịba ụba n'ahụ mmadụ n'ihi ọrụ ezumike ya na-arụ ọrụ).
Oxygen agụụ (hypoxia) nke akwara mgbe ọ gwụsịrị ike ọrụ. Ọnọdụ nke anụ ahụ bụ nwa oge ma na-agafe onwe ya mgbe izu ike gasịrị.
Ọnụnọ nke etuto ahụ n’arụ (malignant ma ọ bụ benign).
Cardiogenic ma ọ bụ hypovolemic ujo.
Ọkpụkpụ Thiamine (Vit B1).
Ọrịa kansa ọbara (leukemia).
Nnukwu ọnya nke na-emetụta ọnụ.
Sepsis.
Ọrịa na mbufụt nke etiologies dị iche iche.
Ọnụnọ nke ịhoụbiga mmanya ókè,
Nnukwu ọbara ọgbụgba.
Ọrịa akpịrị dị na-arịa ọbara.
Nnukwu myocardial infarction.
Okpo iku ume.
Ọdịda ya.
Ọrịa imeju na-adịghị ala ala.
Ọgwụ antiretroviral maka nje HIV. Otu ọgwụ a na - enye oke ahụ, yabụ na o siri ezigbo ike idobe lactic acid nkịtị n'ọbara.

Ihe ịrịba ama nke lactic acidosis

Acos acidis na-etolite n’ọkụ àmụmà, n’ụzọ nkịtị n’ime awa ole na ole. Ihe ịrịba ama mbụ nke lactic acidosis gụnyere:

obodo enweghị mmasị
ihe mgbu n’azụ akwara na akwara ndị ọkpụkpụ,
tụgharịrị uche na mbara igwe,
akpụkpọ anụ mucous na akpụkpọ,
acha odo na anya
onye iku ume ngwa ngwa
Ọdịdị nke ụra ụra na ehighị ụra nke ọma.

A na - egosipụta ụdị ụdị lactic acidosis na onye ọrịa site na ọdịda obi ike. Mmebi dị otú a na-akpalite mgbanwe na nsụzụ nke myocardium (ọnụọgụ nke obi iwe na-abawanye). Ọzọkwa, ọnọdụ ahụ mmadụ niile na-aka njọ, ihe mgbu n'ime afọ, ọgbụgbọ, ọgbụgbọ, afọ ọsịsa, na enweghị agụụ. Mgbe ahụ, a na-agbakwunye mgbaàmà akwara ozi nke lactic acidosis:

areflexia (otu ma ọ bụ karịa reflexes adịghị),
hyperkinesis (nje na -akpata otu ma ọ bụ otu uru ahụ),
paresis (ahụ mkpọnwụ na-ezughị ezu).

Tupu mmalite nke hyperlactacPs coma, mgbanwe nke metabolic acidosis na-apụta: onye ọrịa ahụ na-amalite iku ume miri emi ma na-eme mkpọtụ (a na-eme mkpọtụ nke ọma), site n'enyemaka nke anụ ahụ na-anwa iwepu oke lactic acid n'ahụ ahụ, na DIC - syndrome (coralation intravascular coagulation) na-apụta. Mgbe ahụ enwere ihe mgbaàmà nke ọdịda: nke mbụ, oliguria na-etolite (mbelata oke mmamịrị), na emesịa anuria (enweghị urination). Mgbe mgbe, enwere ngosipụta nke ọbara ọgbụgba ọbara nke mkpịsị aka nke akụkụ ahụ.

Diagnostics

Hyperlactacidemia siri ike ịchọpụta naanị na ọnụnọ nke mgbaàmà nke ọmụmụ na-anaghị enyocha nsonaazụ ule. A na-eji mgbaàmà nke lactic acidosis mee ihe dị ka ihe nnochi anya inye aka. Ọzọ ndị a pụrụ ịtụkwasị obi bụ data nyocha nke nyocha, nke dabere na nha nke lactic acid. Na mgbakwunye, ha na-ekpebi:

ego nke bicarbonates (ya na lactic acidosis, ha na-agbada ngwa ngwa),
ogo nke hyperglycemia,
enweghi acetone na mmamiri (acetonuria).

Gịnị bụ lactic acidosis?

Lactaciosis nke ụdị ọrịa shuga abụọ nke ọrịa mellitus adịkarịghị amalite, mana ọ na-ebute nsonaazụ dị egwu. N'ime 50% nke ikpe, lactic acidosis (hyperlactacidemia) na-egbu egbu.

Ọ bụrụ na anyị na-atụle ihe lactic acidosis bụ site na echiche nke mmiri ọgwụ, mgbe ahụ, nke a bụ ọdịdị nke lactate (lactic acid) na sistemụ mmadụ. Ọ na - ebute n'ihi mmebi nke glucose n'ọtụtụ, nke akụrụ na - enweghị ike

Ahụ mmadụ nwere ahụ ike na -emepụta lactic acid na obere usoro n'ihi usoro metabolic. N'ọtụtụ ọkwa, a na-edozi lactate n'ime mmiri na carbon dioxide ma ọ bụ glucose. Site na mmepe nke lactic acidosis, hyperlactatemia na - apụta - ọnọdụ ebe acidity nke usoro akwara ọbara, mkpụrụ ndụ na - akwụsị iji oxygen zuru oke, mmetụta insulin na - ebelata, na ntụpọ lactic acid na - abawanye na Kama.

Ọ bụrụ na enyeghị onye ọrịa nlekọta ahụike n'oge, hyperglycemic hyperlactacidic coma (lactic acidosis) na-apụta. Yabụ kedu ihe bụ lactic acidosis ma kedu ihe dị ize ndụ nke ọrịa a?

Ihe kpatara mmepe

Lactic acidosis na-etolite ụdị ọrịa shuga mellitus nke 2 n'ime ndị ọrịa nwere ọrịa strok ma ọ bụ infarction myocardial.

Ihe mere maka mmepe nke lactate acidosis nwere ike ịbụ:

egbu egbu egbu
nchịkwa ọgwụ nke nnukwu fructose n'ime ahụ,
ọbara ọgbụgba
ofufe ọrịa na ọrịa
ihe ọmụmụ banyere ahụike nke usoro nke anụ ahụ,
ọnya
nsị na cyanide,
hypovitaminosis B1,
oke anaemia,
ọnụnọ nke ọnya anụrị ma ọ bụ oke ụjọ.

Symptomatology

Ọ bụrụ na onye ọrịa ebido lactic acidosis n'ụdị ọrịa shuga nke 2, a na-achọpụta akara kachasị mma na mbido, ebe ọ bụ na ọrịa a na-arịa ọrịa shuga na-amalite ngwa ngwa ma nwee nsonaazụ kachasị njọ maka onye ọrịa ahụ.

Nyere aha oria ahu - lactic acidosis, ihe omuma ya bu ihe jikoro ya na mmụba nke ọkwa ọbara onye ọrịa.

Innovation na ọrịa shuga - na-a everyụ kwa ụbọchị.

Ihe ịrịba ama nke lactic acidosis nwere foto na-esonụ:

dizziness na isi ọwụwa
ọgbụgbọ na ọgbụgbọ
ndaba,
arụ ọrụ moto,
mgbu afọ
olu mgbu
nsogbu ihi ụra nke ọdịdị dị iche (ụra, ehighị ụra nke ọma),
oke ume iku ume.

Mgbe ị na-achọpụta lactic acidosis, ihe mgbaàmà ahụ kwesịrị njikọta na nsogbu ndị ọzọ enwere ike ịdapụta, ebe ọ bụ na a na-ahụ ihe mgbaàmà ndị ahụ ọ bụghị naanị na nchịkọta lactic acid. Dịka anyị kwuworo n'isiokwu ahụ, lactic acidosis, ihe mgbaàmà mbụ nke edepụtara n'elu, na mpaghara ikpeazụ nke mmepe ahụ gosipụtara site na mwepu nke onye ọrịa na coma.

Ndi oria kwesiri inwe ike ikpebi oria n’onwe ha, imata ihe obu ya na ihe omuma ya na oria shuga, mgbe ahu enwere ohere nke ihe igha nke oma karie. Ka ọrịa ahụ na-etolite, ọnọdụ onye ọrịa na-akawanye ngwa ngwa - ọgbụgbọ, ọgbụgbọ na-egosi.

Ihe ọghọm nke thrombosis na hemorrhagic necrosis nke ala na elu akụkụ nwere ike ịbụ. A ga-akwụrịrị nlebara anya na mmebi nke mgbanwe ahụ na ntanetị akwara imebi ahụ. Onye ọrịa ahụ nwere ike ịchọpụta ọrịa niile a nke lactic acidosis n'onwe ya ma kpọtụrụ dọkịta ozugbo.

Atụmatụ ọgwụgwọ maka ọrịa shuga

Na mmalite ọgwụgwọ, ekwesịrị iburu n'uche na lactate acidosis bụ ọrịa na-amalite site na enweghị oxygen na ọbara. Ọ bụ ya mere mgbatị ọgwụgwọ niile kwesịrị ịdabere na eziokwu ahụ bụ na ọrịa a bụ ụnwụ oxygen nke anụ ahụ. A gha ewepụta mmadụ n’ime steeti a site n’itinye mkpụrụ ndụ nke anụ ahụ na akwara nke anụ ahụ arụ.

Ndị dọkịta maara na a na-adọpụ lactic acidosis na ọrịa shuga mellitus site n'enyemaka nke ventilashị. Iji mee ka onye ọrịa ahụ dị n'ọnọdụ a, ekwesịrị iburu n'uche na ọrịa a bụ hypoxia, nke bụ isi ihe kpatara mmalite na mmepe nke ọrịa ahụ.

Mwepu hypoxia bụ ọrụ dị mkpa maka dọkịta. N'oge usoro ọgwụgwọ, ndị ọkachamara na-enyochakarị ọbara ọgbụgba dị na arịa onye ọrịa, na-enyocha ọkwa nke ihe ịrịba ama niile dị mkpa nke ahụ.

Ọ bụrụ na achọpụtara lactic acidosis na onye ọrịa nke afọ ndụ, ekwesịrị ileba anya n'ihe pụrụ iche gbasara ahụ mmadụ, ebe ọ bụ na afọ nke a na-ebutekarị ọbara mgbali elu, ọrịa imeju nwekwara ike.

A na - eme atụmatụ aghụghọ niile ngwa ngwa o kwere omume, ebe ọ bụ na iyi egwu nke nsonaazụ na - egbu egbu dị oke, na ntụgharị site na steeti nkịtị gaa n'ọrịa ọrịa na - ewe obere oge. Ọ ga - ekwe omume webe naanị acid lais acidisis n'ụlọ ọgwụ. Na ndabere nke nnwale ọbara, ndị dọkịta na-ekpebi ịdị njọ nke ọrịa, na ikpe kachasị njọ mgbe acidity ọbara erughi 7, a na-enye ndị ọrịa bicarbonate potassium bicarbonate.

N'ọnọdụ nke lactic acidosis na-eso ụkọ akwara, a na-eme hemodialysis. Dika usoro ndi ozo, enwere ike ime ihe di na peritoneal dialysis, nke gha eweghachi ozo nke bicarbonate potassium n’ar. Ekwesiri iburu n'uche mgbe a na-ewepụ lactic acidosis na nke a bụ ọrịa chọrọ ọgwụ insulin nke ọma iji weghachi carbohydrate metabolism n'ahụ ahụ onye ọrịa. Ọ dị mkpa iburu n'uche iwepụ lactic acidosis na ọrịa dị otú a chọrọ nlezianya nlezianya nke metabolism metabolism n’ahụ onye ọrịa na-arịa ọrịa shuga mellitus.

Mgbochi na aro

Tupu ịmalite usoro mgbochi, ịkwesịrị ịghọta ihe lactic acidosis bụ ma nwee ike ịmata mgbaàmà ya. Ọrịa ahụ siri ezigbo ike ịchọpụta na ịkọ. Iji gbochie ya, ekwesịrị iburu n'uche na ọrịa a chọrọ izi ezi n'ị takingụ ọgwụ na ịgbaso ndụmọdụ ndị dibia na-aga. Shouldkwesịrị ịgbaso usoro ị theụ ọgwụ ahụ. Ọ bụrụ na ewere mbadamba ya n’oge, anaghị atụ aro ka iwelie dose ahụ n’oge ọzọ ị takeụrụ ọgwụ ahụ, n’ihi na nke a nwere ike ime ka ịdoụbiga mmanya ókè ma ọ bụ bute mmetụta ndị ọzọ.

Kwesịrị ịmara na lactic acidosis nwere ike ịdabere na nzụlite oria ma ọ bụ nje.

N'oge a, ahụ onye ọrịa nwere ọrịa shuga nwere ike ịzaghachi ọgwụ ndị ọ na - ebute. Na mgbaàmà mbụ, ọ dị mkpa ịchọpụta ọrịa na-aga n'ihu na ọgwụgwọ ya. Medicationgwọ onwe ya agaghị adị mma ebe a, yabụ na ọkacha mara ga - edenye ya akwụkwọ mgbe ọ chịkọtara anụnesis. Usoro ọgwụgwọ ga - enyere aka iwepụ ọrịa ahụ ozugbo enwere ike, ọ ga - adịgidekwa na ebe nchekwa onye ọrịa.

Ọrịa shuga na-edugakarị na nsogbu na-egbu egbu. Oké ọbara shuga dị oke ize ndụ.

Aronova S.M. nyere nkọwa banyere ọgwụgwọ ọrịa shuga. Na-agụ zuru ezu

Etiology (ihe kpatara) nke lactic acidosis

Ọnọdụ ndị a na-akpalite mmepe nke lactic acidosis:

Ọrịa na-efe efe
Bleedingdị ọbara ọgbụgba,
Alcoholism n'oge ọrịa ya,
Nkọ
Nnukwu mmerụ ahụ
Ọrịa imeju (nke na-adịghị ala ala).

N'ime ọnụọgụ nke ihe ndị na-akpata lactic acidosis na mgbaàmà nke ụdị kwekọrọ, a na-ekenye ebe pụrụ iche na-ewere biguanides. N'okwu a, akara ngosi lactic acidosis na-eme na ndị ọrịa na-a drugsụ ọgwụ antidiabetic na ọnụnọ nke ihe a na ihe mejupụtara. Ọbụna ntakịrị opekempe ya maka akụrụ na-emetụta ma ọ bụ imeju nwere ike ịkpalite lactic acidosis, nke na-eme ka ọ dịkwuo ukwuu site na ịnakọta ọgwụ ndị a na ahụ.

Mmepe nke lactic acidosis na-apụta na hypoxia nke na-apụta na akwara ọkpụkpụ, nke, dịka ọmụmaatụ, nwere ike jikọta ya na nrụgide anụ ahụ ogologo oge. Ihe kpatara lactic acidosis na-enweghị ọnụnọ pụtara ìhè nke hypoxia nwere ike ije ozi, yana ọtụtụ ụdị usoro usoro tumo. Nke a gụnyekwara iku ume iku ume, nnukwu nkụchi obi nke otu n'ime akpa ume, eriri afọ yana ụkọ nri nke ahuhu.

Lactic acidosis: mgbaàmà

Imirikiti mmepe nke lactic acidosis na-apụta n'ụdị nnukwu n'ime ọtụtụ awa ole na ole, ebe enwere ike inwe ọdịnihu. Mgbe ahụ ndị ọrịa nwere ike ịnwe mgbu na mgbu na-eme n'azụ sternum. Ihe odide njirimara bụ ụdị ọrịa dyspeptik dị iche iche, enweghị mmasị, iku ume ngwa ngwa, ehighi ura, ma ọ bụ, ura, ura.

Ihe mgbaàmà ndị a na-ahụ anya, ka ọ dị ugbu a, bụ ngosipụta n'ụdị ọdịda obi, nke acidosis na-eme ka ike gwụ ya. Megide nzụlite ya, mgbanwe gbanwere na-esote, na-egosipụta na ndị kwekọrịtara ọnụ, njirimara myocardium.

Na mgbakwunye, ọrịa na-aga n'ihu na-agbanwe agbanwe na ọnọdụ mgbanwe nke ọnọdụ ahụike onye ọrịa niile, ebe enwere ike jikọta vomiting na mgbu afọ na mmụba nke acidosis. Ọ bụrụ na ọnọdụ ahụ na-akawanye njọ na lactic acidosis, a na-amata ihe mgbaàmà ahụ n'ọtụtụ akara akwara, site na beflexia na paresis na hyperkinesis.

Ngwa ngwa tupu mmalite nke mmepe nke akpịrị, na mwepu nke mmụọ, enwere ume iku ume, nke a na-eji ụda ume na - egosipụta n'ebe dị anya, ebe isi nke acetone njiri mara nke ihe a bụ ihe adịghị na ikuku. Breathingdị iku ume a na-esokarị metabolic acidosis.

Mgbe ahụ, a na-eji lactic acidosis mara ihe mgbaàmà n'ụdị mbibi: nke mbụ nwere oligoanuria, yana ọzọ yana anuria, megide nzụlite nke mmepe nke coagulation intravascular (ma ọ bụ DIC). Mgbe mgbe, a na-ahụta mgbaàmà nke lactic acidosis site na nrịbama nke intravascular thrombosis nke ọbara ọgbụgba na-emetụta mkpịsị ụkwụ na aka. Okwesiri iburu n'uche na ngwa ngwa mmepe nke lactic acidosis, nke na-eme n'ime awa ole na ole, adịghị enye aka na njirimara nke akara njirimara nke ọrịa shuga. Ihe ịrịba ama ndị a gụnyere akpukpo akpụkpọ ahụ nke akpụkpọ na akpụkpọ ahụ, yana akpụkpọ akọrọ niile. Ọ bụ ihe kwesịrị ịrịba ama na n'ọnọdụ a, ihe ruru 30% nke ndị ọrịa nwere hyperosmolar na ọrịa mamịrị nwere ihe ndị kwekọrọ na nchoputa nke lactate acidosis.

Mgbochi Coma

Mgbochi, nke na - enyere aka igbochi mmalite nke lactacPs coma megide nzụlite lactic acidosis, ihe mgbaàmà nke anyị nyochaworo n’elu, mejupụtara, na - egbochi hypoxia, yana yana njikwa nke nchịkwa na ụgwọ nke ọrịa shuga. Ọzọkwa, lactic acidosis, ihe mgbaàmà nke enwere ike iji ya na ojiji nke biguanides, chọrọ nkwụsi ike na mkpebi siri ike nke usoro ha na kagbuo ozigbo ọ bụrụ ọrịa nke ụdị intercurrent (ma ọ bụ wdg). Lactic acidosis akara ya dịkwa mkpa n’ihe gbasara sistemụ mgbochi, yabụ, ndị ọrịa nwere ọrịa mellitus mgbe ha na-ewere biguanides kwesịkwara ibute atụmatụ a.

Maka enyo ọ bụla gbasara lactic acidosis, yana nuances nke anyị tụlere n'isiokwu ahụ, ị kwesịrị ịkpọtụrụ endocrinologist ozugbo.

Ihe niile ọ dị ziri ezi na ederede si ele ihe anya?

Naanị zaa ya ma ọ bụrụ na ị gosipụtara na ịgwọ ọrịa.

Ọrịa nwere ụdị mgbaàmà:

Ọ bụghị ihe nzuzo na ahụ mmadụ ọ bụla n'oge usoro dị iche iche, gụnyere nri nri, microorganisms na-esonye. Dysbacteriosis bụ ọrịa nke mebiri oke na ihe mejupụtara microorganisms bi na eriri afọ. Nke a nwere ike bute nnukwu nsogbu nke afọ na eriri afọ.

Ike ọgwụgwụ bụ ọnọdụ nke ndị okenye na-echekarị taa, kamakwa ụmụaka. Ihe e ji mara ya bụ ọrụ belatara, ụra ụra, ntị na -eme ihe na mgbakasị ahụ. Ọzọkwa, ọtụtụ mmadụ kwenyere na ịrụbiga ọrụ ókè abụghị nsogbu siri ike, yana ọ dị mma ịrahụ ụra iji wee pụọ. N'ezie, ọ gaghị ekwe omume iwepụ ụdị mmebi a maka ụra dị ogologo. N’aka nke ọzọ, inwe agụụ oge niile ịrahụ ụra na enweghị ike nwetaghachi ike mgbe i hichara ụra bụ ihe mgbaàmà bụ isi ọrụ.

Lactic acidosis (lactic acidosis, lactacidemia, hyperlactatacidemia, lactic acidosis) bụ ọnọdụ nke lactic acid na-abanye n'ọbara ngwa ngwa karịa ka ewepụrụ ya, nke nwere ike ibute mmepe nke nsogbu ndụ. N'ime ihe karịrị 50% nke ikpe, edebara aha acid lais n'ime ndị ọrịa nwere ọrịa mellitus.

Na nzụlite nke lactic acidosis, akụkụ ụbụrụ ya na akụkụ akwara ya na-adịgide, coma na-adịgide, na ọnwụ nwere ike ịmalite.

Lactic acid bụ ngwaahịa ikpeazụ anaerobic glycogenolysis na glycolysis, mkpụrụ nke gluconeogenesis, bụ ihe eji arụ ọrụ site na akwara obi. Mmụba nke ọdịnaya nke lactic acid dị n'ọbara bụ n'ụzọ bụ́ isi ya na inwe ụba ya na akwara ya na mbelata ike nke imeju iji gbanwee lactic acid ka ọ bụrụ glucose na glycogen. N'ihe banyere ọrịa deellensation nke ọrịa shuga, ọkwa nke lactic acid dị n'ọbara nwekwara ike ịba ụba n'ihi igbochi catabolism nke pyruvic acid na mmụba na NAD-N / NAD. Ntinye ọbara nke lactic acid nwere ike ime dị ka nyocha ọzọ.

Ihe Ndị Na-akpata Esemokwu

Hypoxia nke na-eme na akwara nke akwara n'ihi nrụgide anụ ahụ na-adịte aka nwere ike iduga mmepe nke lactic acidosis. Ọzọkwa, usoro a na - efe efe nwere ike ịmalite ọrịa mellitus nke ọrịa shuga, ọrịa neoplasms na-efe efe, ọrịa na-efe efe, ọdịda akụkụ, infarction myocardial, nnukwu ọrịa nke eriri afọ ma ọ bụ akpa ume, akụrụ gbasara akwara, ọrịa imeju na-adịghị ala ala, nnukwu ọbara ọgbụgba, mmerụ ahụ siri ike, mmanya na-adịghị ala ala.

Ihe ndị nwere ọghọm gụnyere:

ọrịa metabolic ọrịa,
ị certainụ ọgwụ ụfọdụ (dịka ọmụmaatụ, biguanides, ọkachasị mgbe ọnya na akụrụ)
ụkọ vitamin nke dị n’ahụ (karịchaa vitamin B 1),
ihe methanol ma ọ bụ ethylene glycol,
ochichi parenteral nke fructose na onunu ogwu.

Site na lactic acidosis, achọrọ ụlọ ọgwụ ngwa ngwa iji dozie acidosis na hypoxia.

Mgbaàmà nke Lactic Acidosis

Lactic acidosis, dịka iwu, na-amalite nnukwu, n'ime awa ole na ole, na-enweghị akara ọ bụla. Ndị ọrịa na-eme mkpesa banyere mgbu olu, mgbu n'azụ sternum, dyspepsia, enweghị mmasị, ụra ma ọ bụ ehighị ụra, iku ume ngwa ngwa. Ọnọdụ ọnọdụ onye ọrịa na-aka njọ ngwa ngwa, mmụba nke acidosis na-esonyere mgbu na afọ na ọgbụgbọ, nsogbu akwara ozi (areflexia, hyperkinesis, paresis).

N'ọnọdụ siri ike, mgbaàmà a na-ahụkarị nke lactic acidosis bụ ngosipụta nke ọdịda obi, akwara acidosis na-eme ka usoro ahụ ka ọ na-aga n'ihu. Ọnwụ nke mmụọ na mmepe nke akpịrị na-aga tupu ịda mba, ọdịdị onye ọrịa na-eku ume ume (ụda ume na-anụ ebe dị anya), ọ nweghịkwa isi acetone na ikuku ekuru. Onye ọrịa ahụ na-etolite ọdịda, buru ụzọ jiri oligoanuria, emesia ya na ọrịa anuria, yana agbasa disagulation intravascular intaguvascular (DIC) sochiri. N'ebe ụfọdụ ndị ọrịa, ọbara ọgbụgba dị mkpịsị aka nke elu na nke ala ka amaara n'etiti akara nke lactic acidosis.

Atụmatụ nke lactic acidosis na ụmụaka

A na-egosipụta ụdị ketara eketa nke lactic acidosis na ụmụaka na-enwe nnukwu acidosis, yana nnukwu nsogbu iku ume. Ndị ọrịa nwere nkwonkwo akwara olu, oge igbu mmadụ n'ọmụmụ psychomotor. Ọtụtụ mgbe, ọnọdụ onye ọrịa na-akawanye mma site na afọ, mana n'ọnọdụ ụfọdụ usoro nchọpụta ahụ na-eduga n'ọnwụ.

Ihe dị ka 50% nke ọrịa lactic acidosis na-akọ na ndị ọrịa nwere ọrịa shuga.

Nsogbu na nsonaazụ nwere ike ime

Na nzụlite nke lactic acidosis, akụkụ ụbụrụ ya na akụkụ akwara ya na-adịgide, coma na-adịgide, na ọnwụ nwere ike ịmalite.

Nnọọ nke ụdị ae nwetara na lactic acidosis na-adabere n'ọrịa na-akpata ọrịa nke o bilitere, n'ogo nke lactic acid dị n'ọbara onye ọrịa, yana n'oge etu esi etinyere ọgwụgwọ ya. Site na mmepe nke nsogbu, yana ụdị ịmụ nwa na lactic acidosis, prognosis na-akawanye njọ.

Nkpugheputa nke oria

Ndị ọrịa mamịrị kwesịrị ịma ihe ịrịba ama nke lactic acidosis. Ọnọdụ a na-amalite ngwa ngwa, n'ime awa ole na ole mmadụ na-arịa ọrịa. Onweghi ihe mgbaàmà oria a na - ewere nke a dịka otu ihe egwu dị na ya.

Ihe ndị a na-egosi mmepe nke ọnọdụ a:

uru ahụ na-apụta
enweghị mmasị
adịghị ike
ike gwụrụ
mgbali mgbali
ndagide, ruo ọnwụ ya,
enweghị urination ma ọ bụ mbelata nke mmụba,
mmepe nke ihe ịrịba ama nke hyperventilation pulmonary hyperventilation (a na-akpọ Kussmaul respiration)
ndakpọ olileanya na mpaghara dị n'azụ azụ,
mgbe onye ọrịa na-akawanye njọ, ọgbụgbọ na-emeghe, mgbu afọ na-apụta.

Ndị a bụ isi ihe ngosipụta nke lactic acidosis na ọrịa shuga. Mgbe ha gosipụtara, ị ga-aga ụlọ ọgwụ ozugbo. N'ime ụlọ ọrụ ahụike, ha nwere ike ịnwe ọbara maka nyocha iji chọpụta mkpokọta lactic acid: ọ na-eto nke ukwuu. Ọkwa karịrị 6 mmol / L.

A na-enyochakwa usoro ihe nlele ndị ọzọ nke hyperlactatemia:

hyperphosphatemia (ule azotemia na-adịghị mma),
ibelata ọbara pH
otu mbelata n'ọkwa CO 2 n'ime ọbara,
mbelata nke mmiri bicarbonates nke plasma.

Inyocha ọbara na mkpebi siri ike nke ndị gosipụtara ihe achọrọ. E kwuwerị, akara nke ọrịa ahụ bụ njirimara nke ọnọdụ ndị ọzọ. Onye na-arịa ọrịa shuga nwere ike ịdaba na nkụma na obere ọkwa shuga n'ime ọbara.

Site na lactic acidosis, nsonaazụ na-egbu egbu ga-ekwe omume: onye ọrịa ahụ nwere nnukwu ọrịa obi, ọrịa akụkụ ụfọdụ nke ahụ, gụnyere akụkụ akụkụ okuku ume.

N'ihi uto, a na-amalite lactacPs coma. Tupu mmalite ya, iku ume na-abịa mara ihe. Ndị ọrịa nwere DIC pụtara. Nke a bụ ọnọdụ nke coagulation intravascular amalite.

Ihe ịrịba ama nke lactic acidosis gụnyekwara ịpụta n ’ọbara ọgbụgba nke mkpịsị aka mkpịsị mkpịsị ọbara. N'otu oge ahụ, amata akpụkpọ mucous na akpụkpọ ahụ.

Usoro ọgwụgwọ

Hyperlactacidemia na ndị ọrịa mamịrị na-etolite na ezughi oke oxygen. Yabụ, na mbụ, n'ụlọ ọgwụ, ọ dị mkpa iji edozi oxygen (anụ ahụ) oxygen ka o kwere mee. A na-eme nke a site na iji ventilashị. Ndị dọkịta kwesịrị iwepụ mmepe hypoxia ozugbo enwere ike.

N'otu oge, a na-enyocha akara niile dị mkpa. A na-elebara ndị agadi anya na-arịa ọbara mgbali.

Ọ bụrụ na enyocha hyperlactatemia site na nyocha, ọkwa pH erughị 7.0, mgbe ahụ onye ọrịa ahụ malitere itinye sodium bicarbonate intravenously. A na-edozi mmiri ahụ site na mmiri na-enweghị atụ, sodium bicarbonate, ihe ha na potassium chloride. Tinye ya na mpekere akara ruo awa 2. Ole ihe ngwọta nwere ike ịdị iche dabere na pH. A na-enyocha ya kwa awa 2 ọ bụla: ọgwụ infusion na-aga n'ihu ruo mgbe pH ruru ihe karịrị 7.0.

Ọ bụrụ na onye nwere ọrịa mamịrị na hyperlactacidemia nwere akụrụ gbasara akwara, mgbe ahụ a na-eme akụrụngwa nke akụrụ.

O kwere omume igbochi mmepe nke ọrịa obi ike site na ịdepụta ọgwụ ndị pụrụ iche. Na obere doses, Reopoliglukin, Heparin ka a ga-edenye. Nhọrọ nke usoro insulin zuru oke di nkpa. Nke a ga-ahazi metabolism metabolism.

Site na mmepe nke lactic acidosis coma, ọgwụ nje na-agbadata nye onye ọrịa. N'otu oge ahụ na-eme ọgwụgwọ antishock. A na-eji Trisamine belata ngosipụta nke lactic acidosis.

Ihe puru omume nke ibido usoro a dika oge nlebara anya nye ulo akwukwo ogwu bu 50%. Ọ bụrụ n’inwe oge ma notaghị ntị na mgbaàmà nke ọrịa a na - aga n’ihu n’ihu, mgbe ahụ ọnwụ nwere ike iru 90%. N’ọnọdụ ndị leghaara anya, ọbụna ndị dọkịta agaghị enwe ike ịzọpụta onye ọrịa.

Mgbaàmà nke lactic acidosis

Nsogbu a na - ebido n’ime awa ole na ole. Ihe mgbaàmà mbu bu:

dobe n'ọbara
adịghị ike
akwara odida
ihe mgbaàmà hyperventilation nke akwara mmiri,
oke aka na ukwu
ọgbụgbọ na ọgbụgbọ
obi ọgba aghara,
iku ume ngwa ngwa
ihe mgbu n’ime afọ na n’azụ akwara.

Ihe mgbaàmà ndị a yiri nnukwu mmụba na shuga ọbara. Ọnọdụ ketoacidosis na-adaba n'okpuru mgbaàmà ndị dị otú ahụ.

Isi ihe dị iche n'etiti ha bụ ọnụnọ nke mgbu na akwara, dị ka mgbe ọzụzụ anụ ahụ gasịrị. Na ketoacidosis, enweghi ihe mgbu.

Ọ bụrụ na onye ọrịa na-arịa ọrịa shuga na-eme mkpesa nke mgbu olu, ọ bara uru ịlele ọkwa shuga dị n'ọbara na ilele ọnọdụ onye ahụ. Ọdịda dị mma na ọdịmma, ọnụnọ nke mgbaàmà ndị a na-egosi lactic acidosis. Kwesịrị ịkpọ ụgbọ ihe mberede. Ọ gaghị ekwe omume ị nyere gị aka mbụ.

Ihe na-akpata lactacidemia

Lactic acidosis nwere ike ịmalite mgbe ị na-a someụ ọgwụ ndị na-ebelata shuga. Ihe mejupụtara ọgwụ ndị dị otú a na-agụnyekarị biguanide umi. Ngwakọta a na - egbochi imeju imebi oke nri lactate. N'ihi ịba ụba nke lactate n’ahụ mmadụ, mmepe nke coma mmiri ara ehi ga-ekwe omume.

Nchịkọta nke lactic acid n'ime anụ ahụ nke anụ ahụ na - apụta n'ihi ụnwụ oxygen nke anụ ahụ, nke, n'aka nke ya, na - eduga n'ịbelata ọkwa pH na ọbara.

Ọrịa ndị e ji hypoxia mee pụrụ ịkpalite lactacidemia. Ndị a bụ ọrịa nke usoro obi. Na njikọta ọrịa shuga, ohere nke lactic acidosis na-abawanye.

Otu n'ime ihe mere mmepe mmiri coma nwere ike ịbụ mmebi metabolic. Lactacidic coma na-etolite n'ime ụmụaka nwere ọrịa shuga.

Zọ ọgwụgwọ

A na-eme ọgwụgwọ nke lactic acidosis na ọrịa shuga mellitus na nlekọta kpụ ọkụ n'ọnụ ma gụnye usoro ndị a:

nchịkwa intraven nke sodium bicarbonate,
ntinye nke methylene acha anụnụ anụnụ iji mee ka ọbara doo ya
ihe iji ọgwụ trisamine mee ihe - na-ewepụ hyperlactatacidemia,
ịba ọcha n'anya na mbelata nke pH n’ime ọbara

Mmepe nke lactic acidosis ga - ekwe omume ọ bụghị naanị ọrịa shuga mellitus, kamakwa n'ọtụtụ ọrịa ndị ọzọ na - esobe mbelata ọkọnọ oxygen na anụ ahụ, ebe ọgbụgba nke glucose na metabolism ike na - apụta dị ka ụdị anaerobic. Ihe eji mara ya bụ otu ihe dị mkpa sitere na lactic acid, nke a na-ahapụ n'ime ọbara.

Ọzọkwa, ọnọdụ a na-efe efe na-ebute ọnụnọ nke ọrịa nke akụkụ ahụ na-eji ma wepu lactic acid. Nke a na-ebute ọrịa nke akụrụ na imeju, bụ nke enweghị ọrụ ha.

E nwere ihe dị iche iche na-eso akpata ụba ụba lactic acid n'ime anụ ahụ, nke na-eduga na lactic acidosis, bụ nke enyere ha.

N'otu oge ahụ, mmụba oxygen dị n'ọbara, ngụgụ anaghị arụ ọrụ nke ọma, akụkụ ahụ niile na-amalitekwa ata ahụhụ na ụkọ oxygen. Iji kwụọ ọnọdụ ahụ, mkpụrụ ndụ na-amalite imebi glucose n'ụdị anaerobic, na mwepụta nke lactate.

Obi ada mba

Ọ na-eduga na ọdịdị nke lactic acidosis nke otu ụdị nke ọdịda pulmonary. Ma imebi obi, enwere mbelata olu ọbara obara site na ventricles ya, nke n’eduba ibute oke oria. Nke a na-akpalite mmụba nke nrụgide na obere ọbara ma na-abanye n'ime oke akụkụ nke akwara umeji, na akụkụ akwara na nkụda obi.

Odida ntaramahụhụ

Akụkụ kachasị nke akụrụ bụ ịhapụ ihe ndị na-adịghị mkpa na nsị na ahụ. Akụrụ na-achịkwa itinye uche n'ihe ndị ọzọ dị na ahụ, ma ọ bụrụ na ha karịrị akarị, akụrụ na-amalite imebisị ha ike karịa, nke na-eme na steeti physiological, nke nwere lactic acid. Ọdịda ntaramahụhụ anaghị arụpụta ihe achọrọ, yana lactic acid na-agbakọ n'ime ahụ.

Site na usoro na-efe efe buru ibu, ihe ndị na-akpata nje na-emebi ọbara ahụ, nsogbu a na-akpalite ịbịanye ọbara.

N'ọnọdụ a, mgbasa ọbara n'ime obere ihe na-akwụsị ma anụ ahụ amalite ịta ahụhụ hypoxia.

Kedu nke na-eme ka mmụba nke ọkwa lactate ọbara.

Ọnọdụ egwu

N'okwu a, ụba mmepụta lactic acid na-apụta na agụụ oxygen nke anụ ahụ n'ihi vasospasm. Nke a na - eme dị ka ihe na - egbochi ahụ mmadụ na - akpata ihe na - emebi ahụ mmadụ, nke a na - ebute mbelata ọbara na - agbatị, ma na - akwalite inye ọbara na akụkụ ahụ.

Ha na - enyere aka iwelie ọnụọgụ nsị dị n'ọbara, na - ebibi imeju na akụrụ, akụkụ ahụ na - ebibi ma wepụ ihe nsị niile n'ahụ. Ọzọkwa, mgbe ethanol mebiri emebi n'oge metabolism, a na-ahapụ ngwaahịa nke ire ere, otu n'ime ha bụ lactic acid.

Usoro Tumor

N'okwu a, enwere mgbanwe n'ụdị metabolism dị na anụ ahụ na-agbanwe ọrịa cancer, a na-ahụkarị ụdị anaerobic metabolism na ntọhapụ nke lactate na ha. Na n'ihi uto nke neoplasm, a na-agbanye arịa ndị na-enye ọbara ọbara, nke na-eduga agụụ agụụ oxygen nke uto na ọrịa ndị agbata obi.

N'ime ndị nwere ọrịa shuga, ụkọ insulin, a na-eme ka enzyme, pyruvate dehydrogenase.

N'oge metabolism nke ume, n'okpuru ọrụ nke ihe a na-arụ ọrụ nke ihe ọkụkụ, pyruvic acid decomposes n'ime ngwaahịa ikpeazụ, yana nkwalite mmepụta nke lactic acid na-eme ka ọ dịkwuo mma. Usoro a na - ebute mmụba nke mkpokọta lactic acid n'ime ọbara. Mana mgbe ị na-a drugsụ ọgwụ hypoglycemic, biguanides, enwere mmụba dị ukwuu na mkpokọta lactate. Nke a bụ n'ihi eziokwu ahụ bụ ọgwụ ọgwụ ndị a na - agbakọ na imeju na akụrụ, na - egbochi ihe ndị dị na akụkụ ahụ na - eme ka mmiri dị lactate.